Guest Blog by Jennifer J. Carroll, PhD MPH (she/her) reprinted from twitter with permission.

Comments in [ ] are from MSTH to offer a Canadian context and/or definitions.

A massive study (>40k people) [by Wakeman et al., 2020] on opioid addiction treatment finds significant reduction in overdose and health complications in patients on on Buprenorphine [Suboxone] and methadone [opioid agonist treatment (OAT)]. Other behavioral or residential care, detox, treatment with naltrexone [a substance that prevents the person from getting a high when they consume opioids], had SAME OUTCOMES AS NO TREATMENT AT ALL.

It's far beyond time to start asking ourselves a few tough questions: --why does SAMHSA {USA based Substance Abuse and Mental Health Services] financially support so many treatment centers that do not offer the only medications for opioid use disorder that are PROVEN to save lives?

[MSTH: We see the same in Canada with provincial governments investing in abstinence based residential programs, such as the recent announcement by the government of Alberta to invest 13 million into such treatment spaces.]

Why are individuals who are arrested and/or imprisoned almost universally denied these life saving medications, regardless of whether they need them or were receiving them from a doctor at time of arrest? Why are we allowing jails and prisons to celebrate themselves for "offering treatment" when all that means is dosing inmates with naltrexone--a medication known to INCREASE overdose risk--the moment they are released?

{MSTH: In Canada some correctional institutions offer OAT (Methadone & Suboxone), but inconsistently at the federal level and even less in provincial jails. Naltrexone is not used to the extend as it is in the US].

Why do so many drug courts refuse participants/defendants access to these medications? Many drug courts will treat prescription methadone and Buprenorphine as "failure" of the court program and will send people back to jail for meds received from their doctor.

[MSTH: Canadian Drug Treatment Courts require people to be abstinent to be in the program and to plead guilty to enter the program. Failure to comply will mean the end of the treatment program send the person to jail.]

This study simply reiterates several scientifically established truths that we have LONG known. This is very important research...but it's not news. We are how many years, how many tens of thousands of preventable deaths into this overdose epidemic now?

So why in the hell are these meds so SO under-used, under-promoted, unknown to people in need, disparages by certain segments of law enforcement, disparaged by certain segments of the recovery community. It makes no sense. Unless you recognize the fact that we hate people who use drugs. We hate them. We, as individuals, as families, as institutions, as a society. We tell them they are weak. We treat them like garbage. We tell them everything they are struggling with is their fault.

When we misplace blame onto people who use for things they can not control, we create this false belief in ourselves that people experiencing addiction need BETTER CHARACTER more than they need proven support---support that doesn't claim to require "rock bottom" to start working.

Let's be clear. "Rock bottom" is not a turning point. It is total abandonment. "Tough love" isn't support. It's abandonment. "A night in jail" isn't treatment. It's jail (h/t @DrKimSue). Anything that isn't proven, effective treatment ...isn't treatment.

If we truly love people living with opioid addiction, we will want them to be healthy and survive. If we want them to be healthy and survive, we MUST defend and fight for access to these meds.

Meds aren't a crutch. ~ Meds aren't a substitute addiction. ~ Meds save lives.

Love is not forcing more pain onto those already suffering.

Love is supporting the choices that people make for themselves when seeking addiction support.

Love is making sure that life saving medications (methadone and Buprenorphine) are ALWAYS among those available choices.

We so often and so tenaciously hate people who use drugs. But we can choose love. Ask where these meds can be accessed in your community. Ask why there isn't nearly enough enough access to meet need/demand. Then go out and fight for more.